NM
Nicky M

1 reviews | Active since Nov 2012

08 Apr 2025, 08:14

Numerous issues with incedent date and supporting documentation

I am yet again having issues with my Kaelo Gap Cover. My son needs to go for a tonsillectomy on 29 April 2025. I visited the ENT on 28/03/2025 and the procedure is booked for 29/04/2025. I did get authorisation from my medical aid on 31/03/2025, but was notified that there is a co-payment that needs to be made to the hospital. On 31/03/2025 is submitted the claim for the co-payment via the Kaelo online portal and also phoned to confirm that the claim was received and it was confirmed that it had received. I submitted the letter from the ENT for the procedure as well as the authorisation letter from the medical confirming the co-payment amount. On 2 April I received an email from Kaelo requesting further documentation from me and indicating that the incident date was 29/03/2025 which was incorrect. I then phoned them on 03/04/2025 explaining them that the incident date is incorrect. I also emailed them the authorisation letter from the medical aid as well as the letter from the ENT confrirming the procedure on 29/04/2025. Ad this is a future dated procedure, there will, logically, not be a hospital account nor a medical aid statement as the procedure had not taken place yet. I also stated in the mail that the incident date is incorrect. On 04/03/2025 I received a mail confirming that the supporting documentation has been received. On 07/04/2025 I received yet another mail from Kaelo requesting a hospital statement for 29/03/2025 as well as medical aid statement for 29/03/2025. Again, the incident date was noted as 29/03/2025. THE DATE FOR THE PROCEDURE IS 29/04/2025 AND NOT 29/03/2025. There will not be a hospital statement nor a medical aid statement as the procedure requires a co-payment as well the simple fact that the procedure has not taken place yet. I am at my wits end with having to explain this and I am hoping someone higher up will contact me in order to get this resolved. At this stage I am wondering if this is a stalling tactic to delay the pay-out of the claim...

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Replies (5)
Kaelo
Kaelo's reply08 Apr 2025, 09:12
Official
That is quite concerning to hear and we are very sorry for the delays. Kindly note that this has been escalated to our team and they will be in touch to assist you in anyway possible. 

Best regards,

NM
Nicky M's update08 Apr 2025, 09:13
Reviewer Update
Thank you for the prompt reply, I am eagerly awaiting their contact.
Kaelo
Kaelo's reply08 Apr 2025, 11:22
Official
Hello there, we hope our team was able to assist with your complaint. 

Best regards,

NM
Nicky M's update08 Apr 2025, 11:32
Reviewer Update
I am still awaiting final feedback on this, thanks
Kaelo
Kaelo's reply09 Apr 2025, 12:21
Official
Thank you, we hope for a quick resolve.

Best regards,